全髋关节置换后异位骨化的成因及影像诊断

Etiology and diagnostic imaging of heterotopic ossification after total hip arthroplasty

背景:异位骨化为全髋关节置换后常见的并发症之一,多无明显临床症状,但较严重的异位骨化可引起患者术后疼痛及关节活动度减低。异位骨化的发病机制尚不完全清楚,有多种因素可以增加异位骨化的发生率。由于目前临床上尚无有效的非手术方法治疗成熟的异位骨化,故对于异位骨化的早期诊断尤为重要。目的:总结目前全髋关节置换后异位骨化的相关研究进展。方法:第一作者以"total hip arthroplasty,heterotopic ossification"为英文检索词,以"全髋关节置换术,并发症,异位骨化"为中文检索词,通过PubMed、Springerlink英文数据库及CNKI中国期刊全文数据库检索2008至2018年间的相关文献。初检得到相关英文文献278篇,中文文献97篇,筛选后纳入53篇进行分析总结。结果与讨论:①目前对于异位骨化的发病机制尚不完全清楚,与全身及局部因素均有关;②异位骨化的危险因素分为可变因素及不可变因素,通常认为年龄、男性、强直性脊柱炎、既往髋部手术史、髋关节强直等因素可增加异位骨化的发生率;③异位骨化的确诊主要依靠影像学检查,不同时期异位骨化的影像学表现有所不同,且不同的影像学检查方法对于异位骨化检测的敏感性和特异度也有区别;④异位骨化的危险因素仍存在很多不同结论,且没有公认的最佳影像学检查方法,但众多研究及分析结果可为临床预防及诊断全髋关节置换后异位骨化提供相应依据。

BACKGROUND: Heterotopic ossification is a common complication after total hip arthroplasty, and there are no obvious clinical symptoms,but more severe heterotopic ossification can cause postoperative pain and joint mobility. The pathogenesis of heterotopic ossification is not fully understood, and there are many factors that can increase the incidence of heterotopic ossification. Because there is no effective non-surgical treatment of mature heterotopic ossification in clinical practice, it is especially important for the early diagnosis of heterotopic ossification.OBJECTIVE: To summarize the current research and progress of heterotopic ossification after total hip arthroplasty.METHODS: The first author searched PubMed, Springerlink and CNKI databases for the articles between 2008 and 2018. The keywords were'total hip arthroplasty, heterotopic ossification' in English and Chinese, respectively. Totally 278 English articles and 97 Chinese articles were retrieved, and 53 eligible articles were included for analysis and summary.RESULTS AND CONCLUSION:(1) At present, the pathogenesis of heterotopic ossification is not fully understood, and is related to systemic and local factors.(2) The risk factors for heterotopic ossification are divided into variable factors and invariable factors, and age, man, ankylosing spondylitis, history of hip surgery, hip ankylosis and other factors can increase the incidence of heterotopic ossification.(3) The diagnosis of heterotopic ossification mainly depends on imaging examination. The imaging findings of heterotopic ossification in different periods are different,and the sensitivity and specificity of different imaging examination methods for heterotopic ossification are also different.(4) There are various conclusions about the risk factors of heterotopic ossification, and there is no recognized best imaging examination method, but many research and analysis results can provide a basis for clinical prevention and diagnosis of heterotopic ossification after total hip arthroplasty.